Background: The most common congenital abnormality of urinary tract is duplex kidney but horseshoe kidney (HSK) represent the most common congenital renal fusion anomaly.¹ Pelvi-ureteric junction obstruction (PUJO) is a relatively common finding during urological investigation. The combination of HSK and PUJO occurs in 15-33% of patients. Surgical treatment can be challenging in such cases. Herein, we report our experience of management of PUJO in HSK.

Materials and Methods: In between July 2012 and April 2017, fourteen patients were identified with the horseshoe kidney having PUJO. There demographic, diagnostic, and procedural data were recorded. All cases were investigated with renal ultrasonography, computed tomography (CT) and renal scintigraphy. Surgical repair of PUJO by pyeloplasty was done in nine cases. Hellstrom repair was done in three cases and two cases underwent nephrectomy. Treatment outcome was assessed in terms of quality of life, recurrence and complications.

Results: Median age of presentation was 30.78 years (9-51 years) . At a mean follow-up of 22 months all were symptomatic free.  Out of fourteen, ten patients presented with flank pain. Incidental hydronephrosis was detected in two patients, and two had a recurrent febrile urinary tract infection. Out of nine patients who underwent pyeloplasty, Anderson-Hynes dismembered pyeloplasty was performed in five and foley y-v plasty was performed in four patients. Hellstrom repair was done in three cases and two patients underwent nephrectomy. Laparoscopy surgey was done in two patients each of Anderson-Hynes dismembered pyeloplasty and Hellstrom repair. Nephrectomy was done in one patient by laparoscopy who developed chyluria later on and was managed conservatively. No complications were detected in others during follow-up and all had a good quality of life.

Conclusions: PUJO in horseshoe kidneys is a surgical challenge. Treatment should be individualized depending upon the clinical profile of patient.

Keywords: Horseshoe kidney (HSK); Pelvi-ureteric junction obstruction (PUJO); Pyeloplasty; Laparoscopy.

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Priyabrata Das

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